Cryptococcosis

Cryptococcus neoformans.
 Cryptococcosis
• Cryptococcosis is a chronic, subacute to acute
pulmonary, systemic or meningitis disease
• Cryptococcus neoformans var. neoformans and
Cryptococcus neoformans var. gattii
– encapsulated yeast
– The species has 4 serotypes (A,B,C,D)
based on capsular polysaccharide antigen
– C. neoformans var neoformans serotype A
 Cryptococcosis
• Epidermiology
– distributed worldwide, pigeon feces,
eucalyptus trees (var. gattii)
• Transmission by inhalation of
basidiospore or yeast cells
• Cryptococcal infections in hosts who
are immunosuppressed, including
patients with AIDS
 Transmission

Inhalation respiratory infection dissiminated

 Clinical features

- sub acute meningitis

- meningoencephalitisCNS cryptococcosis
– Most common clinical presentation of
cryptococcosis: Cryptococcal meningitis
– Prolong evolution of several months
– headache, vomiting, neck stiffness,
mental status
: 1/3 have evidence of pulmonary
involvement
- cough , dyspnea
- abnormal CXR
: Disseminated infection
 Cryptococcosis
• Pulmonary cryptococcosis
– asymptomatic
– x-ray

Right upper lobe

This is Cryptococcus neoformans infection of the lung. There are numerous
organisms that have a large mucoid capsule, giving the appearance of a clear
zone around a faint round nucleus.
 Cryptococcosis
• Cutaneous & mucocutaneous cyptococcosis

• Osseous cyrtococcosis : bone

• Visceral crytococcosis : heart, kidneys, liver,
 Cryptococcus antigen

: highly sensitive and specific ( > 1:8 )

: screening test for febrile patient
 Laboratory diagnosis

capsule

capsule

India ink test Mucicarmine stain

India ink test : detect the extensive capsule

This is an India ink preparation of cerebrospinal fluid in a patient with
Cryptococcus neoformans meningitis. Note the clear zone of the capsule
around the central nucleus of the organisms.
• Examination of CSF :
- mildly elevation CSF protein
- normal or slightly low glucose
- a few lymphocytes.
- numerous organism

• Latex agglutination test : detect

cryptococcal antigen
• Patient improves : titer
• No respond to therapy ; titer

 Laboratory diagnosis
• Culture: 370C, 1-2 days
– SDA with out cyclohexamide:
creamy, white and mucoid
– Birdseed agar: brown to black
colony SDA
– Urease positive

Birdseed agar - ve/+ve

 Diagnosis and treatment of
Cryptococcus meningitis

HIV positive patient CD4

lymphocyte count <200,000/ml

History suggestive of
cryptococcal meningitis( CM )

( and /or )

Headaches , fever ,with/without Positive serum cryptococcal

mental status changes antigen
 Lumbar puncture Lumbar puncture

No evidence of CM No evidence of CM
continue diagnostic Evidence of CM fluconazole 200 mg
evaluation Positive culture orally indefinitely

for Cryptococcus
neoformans,
positive India ink
stain

Amphotericin 8 ( 0.7 mg/kg/day ) iv

plus flucytosine (25mg/kg) q6h for 2
week , then fluconzole 400 mg po for
8 weeks, then fluconazole 200mg po
for life